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    1. Interaction Between the Distribution of Diabetic Retinopathy Lesions and the Association of Optical Coherence Tomography Angiography Scans With Diabetic Retinopathy Severity

      Interaction Between the Distribution of Diabetic Retinopathy Lesions and the Association of Optical Coherence Tomography Angiography Scans With Diabetic Retinopathy Severity

      Importance Studies have not yet determined whether the distribution of lesions in the retinal periphery alters the association between the severity of diabetic retinopathy (DR) and macular vessel density. Objective To evaluate the association of DR lesion distribution with optical coherence tomography angiography (OCTA) metrics and DR severity. Design, Setting, and Participants This cross-sectional observational study was conducted at a tertiary care center for diabetic eye disease among 225 patients with type 1 or 2 diabetes who had undergone imaging between February 15, 2016, and December 31, 2019. Exposures Optical coherence tomography angiography 3 × 3-mm macular scans and ultra-widefield color ...

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    2. Using Optical Coherence Tomography as a Surrogate of Measurements of Intracranial Pressure in Idiopathic Intracranial Hypertension

      Using Optical Coherence Tomography as a Surrogate of Measurements of Intracranial Pressure in Idiopathic Intracranial Hypertension

      Importance There is an unmet need for noninvasive biomarkers of intracranial pressure (ICP), which manifests as papilledema that can be quantified by optical coherence tomography (OCT) imaging. Objective To determine whether OCT of the optic nerve head in papilledema could act as a surrogate measure of ICP. Design, Setting, and Participants This longitudinal cohort study used data collected from 3 randomized clinical trials that were conducted between April 1, 2014, and August 1, 2019. Participants who were female and had active idiopathic intracranial hypertension were enrolled from 5 National Health Service hospitals in the UK. Automated perimetry and OCT imaging ...

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    3. Diagnosis and Grading Of Papilledema Using Optical Coherence Tomography Compared To Clinical Staging By Frise´n Scale

      Diagnosis and Grading Of Papilledema Using Optical Coherence Tomography Compared To Clinical Staging By Frise´n Scale

      Objectives To compare and contrast 2 methods of quantitating papilledema, namely, optical coherence tomography (OCT) and Modified Frisén Scale (MFS). Methods Digital optic disc photographs and OCT fast retinal nerve fiber layer (RNFL) thickness, fast RNFL map, total retinal thickness, and fast disc images were obtained in 36 patients with papilledema. Digital optic disc photographs were randomized and graded by 4 masked expert reviewers using the MFS. We performed Spearman rank correlations of OCT RNFL thickness, OCT total retinal thickness, and MFS grade from photographs. Results OCT RNFL thickness and MFS grade from photographs correlated well ( R = 0.85 ...

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    4. Progression of Photoreceptor Degeneration in Geographic Atrophy Secondary to Age-related Macular Degeneration

      Progression of Photoreceptor Degeneration in Geographic Atrophy Secondary to Age-related Macular Degeneration

      Importance Sensitive outcome measures for disease progression are needed for treatment trials in geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Objective To quantify photoreceptor degeneration outside regions of GA in eyes with nonexudative AMD, to evaluate its association with future GA progression, and to characterize its spatio-temporal progression. Design, Setting, and Participants Monocenter cohort study (Directional Spread in Geographic Atrophy [ NCT02051998 ]) and analysis of data from a normative data study at a tertiary referral center. One hundred fifty-eight eyes of 89 patients with a mean (SD) age of 77.7 (7.1) years, median area of GA of ...

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    5. Model-to-Data Approach for Deep Learning in Optical Coherence Tomography Intraretinal Fluid Segmentation

      Model-to-Data Approach for Deep Learning in Optical Coherence Tomography Intraretinal Fluid Segmentation

      Importance Amid an explosion of interest in deep learning in medicine, including within ophthalmology, concerns regarding data privacy, security, and sharing are of increasing importance. A model-to-data approach, in which the model itself is transferred rather than data, can circumvent many of these challenges but has not been previously demonstrated in ophthalmology. Objective To determine whether a model-to-data deep learning approach (ie, validation of the algorithm without any data transfer) can be applied in ophthalmology. Design, Setting, and Participants This single-center cross-sectional study included patients with active exudative age-related macular degeneration undergoing optical coherence tomography (OCT) at the New England ...

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    6. Association of Optical Coherence Tomography Angiography Metrics With Detection of Impaired Macular Microvasculature and Decreased Vision in Amblyopic Eyes

      Association of Optical Coherence Tomography Angiography Metrics With Detection of Impaired Macular Microvasculature and Decreased Vision in Amblyopic Eyes

      Importance Microvascular abnormalities in amblyopia are becoming evident with high-resolution imaging, such as optical coherence tomography angiography (OCT-A); however, to our knowledge, the clinical significance and use of these findings are unknown. Objective To assess changes in quantitative OCT-A metrics in amblyopic eyes and explore their association with visual acuity in children. Design, Setting, and Participants This population-based nested case-control study included children aged 6 to 8 years who were consecutively recruited between January 2016 and July 2017 from the population-based Hong Kong Children Eye Study (HKCES) at the Chinese University of Hong Kong Eye Centre. All participants underwent OCT-A ...

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    7. Optical Coherence Tomography Angiography as an Important Diagnostic Tool for Amblyopia

      Optical Coherence Tomography Angiography as an Important Diagnostic Tool for Amblyopia

      Amblyopia has been a diagnosis of exclusion. Besides best-corrected visual acuity, there are presently no standardized metrics that are used for the diagnosis and evaluation of amblyopia. For more than a decade, studies using structural optical coherence tomography (OCT) had identified several differences between amblyopic and control eyes. 1 Qualitatively, the increase in height of the ellipsoid zone at the central fovea was noted to be attenuated or absent in 60% of amblyopic eyes compared with 29% of normal eyes. 2 Several studies had reported that the foveal minimum thickness was greater in amblyopic eyes compared with normal controls, but ...

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    8. Association of Intravitreal Aflibercept With Optical Coherence Tomography Angiography Vessel Density in Patients With Proliferative Diabetic Retinopathy: A Secondary Analysis of a Randomized Clinical Trial

      Association of Intravitreal Aflibercept With Optical Coherence Tomography Angiography Vessel Density in Patients With Proliferative Diabetic Retinopathy: A Secondary Analysis of a Randomized Clinical Trial

      Importance Although previous studies have evaluated the association between anti–vascular endothelial growth factor therapy and macular vessel density, they were confounded by the presence of macular edema, which may be associated with artifacts and segmentation errors in optical coherence tomography angiography (OCTA). Objective To evaluate the association of intravitreal aflibercept with changes in macular vascular density using OCTA in patients with proliferative diabetic retinopathy without diabetic macular edema. Design, Setting, and Participants This post hoc analysis of a randomized clinical trial used data on 40 eyes of 40 patients with proliferative diabetic retinopathy without diabetic macular edema who were ...

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    9. Steps Forward in Analyzing Optical Coherence Tomography in Age-Related Macular Degeneration—Capitalizing on the Power of Artificial Intelligence

      Steps Forward in Analyzing Optical Coherence Tomography in Age-Related Macular Degeneration—Capitalizing on the Power of Artificial Intelligence

      Imaging of the retina, originally by stereoscopic fundus photography and later by optical coherence tomography (OCT), has been essential to the diagnosis and monitoring of progression of age-related macular degeneration. Manual grading of color photographs acquired during the Age-Related Eye Disease Study to detect and quantify drusen and pigmentary changes led to a detailed severity scale that stratified 5-year risk of late AMD into 9 categories, with risk estimates ranging from 1% to 50%. 1 The high resolution of spectral-domain OCT now allows visualization of the retinal microanatomy. Drusen and focal areas of hyperpigmentation are associated with specific findings on ...

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    10. Characterization of Drusen and Hyperreflective Foci as Biomarkers for Disease Progression in Age-Related Macular Degeneration Using Artificial Intelligence in Optical Coherence Tomography

      Characterization of Drusen and Hyperreflective Foci as Biomarkers for Disease Progression in Age-Related Macular Degeneration Using Artificial Intelligence in Optical Coherence Tomography

      Importance The morphologic changes and their pathognomonic distribution in progressing age-related macular degeneration (AMD) are not well understood. Objectives To characterize the pathognomonic distribution and time course of morphologic patterns in AMD and to quantify changes distinctive for progression to macular neovascularization (MNV) and macular atrophy (MA). Design, Setting, and Participants This cohort study included optical coherence tomography (OCT) volumes from study participants with early or intermediate AMD in the fellow eye in the HARBOR (A Study of Ranibizumab Administered Monthly or on an As-needed Basis in Patients With Subfoveal Neovascular Age-Related Macular Degeneration) trial. Patients underwent imaging monthly for ...

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    11. Bilateral Enlargement of the Foveal Avascular Zone on Optical Coherence Tomography Angiography Associated With Cocaine Use

      Bilateral Enlargement of the Foveal Avascular Zone on Optical Coherence Tomography Angiography Associated With Cocaine Use

      Cocaine is a well-known cause of vascular injury and secondary end-organ damage. The presented case demonstrates retinal vascular abnormalities associated with a history of cocaine use in the absence of other retinal disease. A 61-year-old Latino man was referred for evaluation of gradual worsening near visual acuity and an inability to find a satisfactory refraction. His best-corrected visual acuity was 20/30 in each eye. Optical coherence tomography demonstrated bilateral inner retinal atrophy with disruption of the inner retinal layers and effacement of the foveal contour ( Figure 1 ). These changes spanned multiple vascular distributions. Fluorescein angiogram showed an enlarged foveal ...

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    12. Visualization of the Human Intracranial Vasa Vasorum In Vivo Using Optical Coherence Tomography

      Visualization of the Human Intracranial Vasa Vasorum In Vivo Using Optical Coherence Tomography

      The vasa vasorum are a specialized microvasculature that mainly arise from the adventitia and traverse the intimomedial layer of large arteries and veins. These are felt to serve as crucial routes of the delivery for trophic and nutritive factors, as well as regulatory signals. 1 Importantly, they also play a role in pathology via proliferation in atherosclerotic and hypertrophic intimomedia, as well as plaque hemorrhage and dissection via rupture. 2 In the setting of symptomatic vertebral artery stenosis, we report what is, to our knowledge, the first known in vivo visualization of the human native intracranial arterial vasa vasorum and ...

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    13. Reversal of Cupping in an Infant, Shown by Optical Coherence Tomography

      Reversal of Cupping in an Infant, Shown by Optical Coherence Tomography

      A 10-month-old white male infant with primary congenital glaucoma underwent successful goniotomy in the right eye, lowering intraocular pressure from 34 mm Hg to 11 mm Hg and decreasing axial length from 23.4 mm to 22.8 mm. We used optical coherence tomography (HRA+OCT Spectralis with Flex module [Heidelberg Engineering]) to image the optic nerve preoperatively and at 1 month postoperatively. The cup-disc ratio decreased from 0.6 to 0.4. The reversal of cupping was associated with decreased cup depth and an anterior shift of the Bruch membrane on optical coherence tomography ( Figure ). Notably, the preoperative and ...

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    14. Anterior Segment Optical Coherence Tomography Angiography of Iris Neovascularization After Intravitreal Ranibizumab and Panretinal Photocoagulation

      Anterior Segment Optical Coherence Tomography Angiography of Iris Neovascularization After Intravitreal Ranibizumab and Panretinal Photocoagulation

      A 58-year-old Japanese man with diabetes presented with blurred vision in his right eye. His intraocular pressure was 53 mm Hg and the peripheral anterior synechia index was around 20%. The anterior segment optical coherence tomography (OCT) angiography image showed that the iris neovascularization was marked around the pupil in the superficial layer ( Figure , A; green shading). 1 Anterior segment OCT angiography using a swept-source OCT system enabled the visualization of physiological radial vessels in the stroma, even in a brown eye ( Figure , A; red shading). Panretinal photocoagulation was administered immediately and completed in 3 separate installments over 1 month ...

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    15. Quantitative Microvascular Analysis With Wide-Field Optical Coherence Tomography Angiography in Eyes With Diabetic Retinopathy

      Quantitative Microvascular Analysis With Wide-Field Optical Coherence Tomography Angiography in Eyes With Diabetic Retinopathy

      Importance Wide-field optical coherence tomographic angiography (OCTA) may provide insights to peripheral capillary dropout in eyes with diabetic retinopathy (DR). Objective To describe the diagnostic performance of wide-field OCTA with and without large vessel removal for assessment of DR in persons with diabetes. Design, Setting, and Participants This case-control study was performed from April 26, 2018, to April 8, 2019, at a single tertiary eye center in Singapore. Case patients were those with type 2 diabetes for more than 5 years and bilateral DR diagnosed by fundus imaging; control participants included those with no self-reported history of diabetes, a fasting ...

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    16. Optical Coherence Tomography Angiography Recovery Pattern of Acute Macular Neuroretinopathy

      Optical Coherence Tomography Angiography Recovery Pattern of Acute Macular Neuroretinopathy

      A 73-year-old man had acute vision loss in his right eye, following pacemaker dysfunction during the early postimplantation period. He had second-degree atrioventricular block. Best-corrected visual acuity was 20/63 OD. Anterior segment examination was unremarkable. Humphrey visual field 10-2 testing revealed a paracentral scotoma of the right eye. Fundus photography revealed a brown-reddish foveal reflex ( Figure 1 A). Near-infrared imaging showed a parafoveal multilobular hyporeflective area ( Figure 1 B). Spectral-domain optical coherence tomography (SD-OCT) (Spectralis HRA and SD-OCT; Heidelberg Engineering GmbH) demonstrated hyperreflectivity of the outer plexiform layer and Henle fiber layer associated with subretinal fluid, consistent with acute ...

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    17. Retinal Neovascularization–Simulating Retinal Capillary Reperfusion in Branch Retinal Vein Occlusion, Imaged by Wide-Field Optical Coherence Tomography Angiography

      Retinal Neovascularization–Simulating Retinal Capillary Reperfusion in Branch Retinal Vein Occlusion, Imaged by Wide-Field Optical Coherence Tomography Angiography

      Retinal neovascularization is a complication of retinal vascular diseases, such as diabetic retinopathy, retinopathy of prematurity, and retinal vein occlusion. Anti–vascular endothelial growth factor therapy or laser photocoagulation arrests proliferative retinopathy after neovascularization; however, substantial reperfusion has sometimes been reported. 1 - 3 We report a case of branch retinal vein occlusion manifesting with retinal nonperfusion, covered by retinal neovascularization and appearing as retinal capillary reperfusion. In this case, optical coherence tomography angiography (OCTA) showed distinct neovascularization on the vitreoretinal surface, although there was minimal leakage from the neovascularized area on fluorescein angiography (FA) images.

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      Mentions: Osaka University
    18. Conjunctival and Episcleral Blood Flow Restoration After Strabismus Surgery on Swept-Source Optical Coherence Tomography Angiography

      Conjunctival and Episcleral Blood Flow Restoration After Strabismus Surgery on Swept-Source Optical Coherence Tomography Angiography

      A woman in her 60s presented with hyperexotropia after a recession of bilateral medial rectus muscles for infantile esotropia was performed at age 11 years. She was also experiencing recession of a treatment-naive lateral rectus muscle and advancement of a recessed medial rectus muscle, with a 1 tendon–width downward transposition of the left eye. Swept-source optical coherence tomography angiography (OCTA; PLEX Elite 9000 [Carl Zeiss Meditec]) with a 10-diopter optical adaptor lens was performed on the recessed lateral rectus muscle. The OCTA images suggested that conjunctival and episcleral blood flow decreased immediately after surgery ( Figure , A) but was restored ...

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    19. Pearls and Pitfalls of Optical Coherence Tomography Angiography Image Interpretation

      Pearls and Pitfalls of Optical Coherence Tomography Angiography Image Interpretation

      The advent of optical coherence tomography angiography (OCTA), a relatively new tool to image the retinal and choroidal microvasculature with depth-resolved capability, has been met with great excitement by some ophthalmologists. This noninvasive technology is a potentially valuable instrument to differentiate flow impairment in the superficial vs deep retinal capillary plexus, and it can quantify nonperfusion in eyes with retinal vascular disease. Moreover, OCTA has advanced understanding of the microvascular morphology of choroidal neovascularization and has demonstrated its various growth patterns.  It also has highlighted the potential importance of inner choroidal flow impairments associated with the development and progression of ...

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    20. Clinical Practice Settings vs Clinical Trials Is Artificial Intelligence the Answer?

      Clinical Practice Settings vs Clinical Trials Is Artificial Intelligence the Answer?

      At clinical conferences and in publications, use of the term real world is widespread. It describes physicians’ accumulated experience in treating patients. It is contrasted with academic trials. Randomized clinical trials differ from practice in that they have fixed prespecified inclusion and exclusion criteria, adherence to a prespecified protocol, and ideally good patient retention. Randomized clinical trials have an advantage against observational studies when comparing treatments because they largely control for confounders, bias, and chance. Patient and treatment selection bias, losses to follow-up, outcome measurement, and imaging variability as well as many other confounding and bias factors can have large ...

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    21. Assessing the Use of Incorrectly Scaled Optical Coherence Tomography Angiography Images in Peer-Reviewed Studies

      Assessing the Use of Incorrectly Scaled Optical Coherence Tomography Angiography Images in Peer-Reviewed Studies

      Importance Individual differences in axial length affect the lateral magnification of in vivo retinal images and as a result can affect the accuracy of quantitative measurements made from these images. As measurements from optical coherence tomography angiography (OCTA) images are becoming increasingly used in the diagnosis and monitoring of a wide range of diseases, evaluating which studies use correctly scaled images is crucial to their interpretation. Objective To perform a systematic literature review to assess the percentage of articles that report correcting the scale of their OCTA images for individual differences in retinal magnification. Evidence Review A PubMed (MEDLINE) search ...

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    22. Optical Coherence Tomography Monitoring in a Patient With Retinoblastoma

      Optical Coherence Tomography Monitoring in a Patient With Retinoblastoma

      A 17-month-old girl with group B retinoblastoma in her right eye developed recurrence of a parafoveal tumor ( Figure , A) after 6 cycles of intravenous chemotherapy. Despite treatment with indocyanine green–enhanced transpupillary thermotherapy, optical coherence tomography (vertical orientation) demonstrated continued tumor growth toward the foveola. The patient was subsequently treated with 2 cycles of intra-arterial chemotherapy, after which complete tumor regression to a flat scar was documented clinically and by optical coherence tomography (vertical orientation) ( Figure , B). The foveola remained intact. Optical coherence tomography may be a helpful tool in the documentation of retinoblastoma response, particularly in patients with small ...

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    23. Optical Coherence Tomography Angiography in a Patient With Diabetes and Preretinal Neovascularization

      Optical Coherence Tomography Angiography in a Patient With Diabetes and Preretinal Neovascularization

      A 39-year-old patient with type 2 diabetes (diagnosed in 1996) presented for an evaluation of bilateral proliferative diabetic retinopathy that had been treated previously with panretinal photocoagulation. His visual acuity was 20/25 OD. Examination by ophthalmoscopy showed scattered dot-blot intraretinal hemorrhages and an inferotemporal preretinal neovascular frond ( Figure , A). Optical coherence tomography angiography was also performed ( Figure , B).

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    24. Effects of Flavanol-Rich Dark Chocolate on Visual Function and Retinal Perfusion Measured With Optical Coherence Tomography Angiography

      Effects of Flavanol-Rich Dark Chocolate on Visual Function and Retinal Perfusion Measured With Optical Coherence Tomography Angiography

      Importance A recently reported randomized clinical trial suggested beneficial effects of vasodilating flavanols in dark chocolate on visual function without objective quantification of retinal perfusion. Objective To assess the effects of dark chocolate flavanols on subjective visual function and retinal perfusion objectively quantified on optical coherence tomography (OCT) angiography. Design, Setting, and Participants This randomized, masked double-blind crossover clinical trial analyzed 22 healthy participants at the Department of Ophthalmology, Ludwig Maximilians-University Munich, Germany, in July 2018. Analysis was intention to treat. Analysis began in July 2018. Interventions Participants were randomized to consume 20 g of dark chocolate containing 400 mg ...

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